Provider Demographics
NPI:1093045437
Name:MONTGOMERY EYE CARE, P.A.
Entity Type:Organization
Organization Name:MONTGOMERY EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BONAME
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-279-0005
Mailing Address - Street 1:1325 ROUTE 206
Mailing Address - Street 2:SUITE 24
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-1922
Mailing Address - Country:US
Mailing Address - Phone:609-279-0005
Mailing Address - Fax:609-279-0004
Practice Address - Street 1:1325 ROUTE 206
Practice Address - Street 2:SUITE 24
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-1922
Practice Address - Country:US
Practice Address - Phone:609-279-0005
Practice Address - Fax:609-279-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00529800261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1932132024OtherNPI (INDIVIDUAL)
NJ1093045437OtherNPI (GROUP)
NJ1093045437OtherNPI (GROUP)
NJ1932132024OtherNPI (INDIVIDUAL)
NJU68327Medicare UPIN
NJ171342Medicare PIN